Introduction:Western media coverage of the violence associated with the 2003 US-led invasion of Iraq has contrasted in magnitude and nature with population-based survey reports.Objectives:The purpose of this study was to evaluate the extent to which first-hand reports of violent deaths were captured in the English language media by conducting in-depth interviews with Iraqi citizens.Methods:The England-based Iraq Body Count (IBC) has methodically monitored media reports and recorded each violent death in Iraq that could be confirmed by two English language media sources. Using the capturerecapture method, 25 Masters' Degree students were assigned to interview residents in Iraq and asked them to describe 10 violent deaths that occurred closest to their home since the 2003 invasion. Students then matched these reports with those documented in IBC. These reports were matched both individually and crosschecked in groups to obtain a percentage of those deaths captured in the English language media.Results:Eighteen out of 25 students successfully interviewed someone in Iraq. Six contacted individuals by telephone, while the others conducted interviews via e-mail. One out of seven (14%) phone contacts refused to participate. Seventeen out of 18 primary interviewees resided in Baghdad, however, some interviewees reported deaths of neighbors that occurred while the neighbors were elsewhere. The Baghdad residents reported 161 deaths in total, 39 of which (24%) were believed to be reported in the press as summarized by IBC. An additional 13 deaths (8%) might have been in the database, and 61 (38%) were absolutely not in the database.Conclusions:The vast majority of violent deaths (estimated from the results of this study as being between 68–76%) are not reported by the press. Efforts to monitor events by press coverage or reports of tallies similar to those reported in the press, should be evaluated with the suspicion applied to any passive surveillance network: that it may be incomplete. Even in the most heavily reported conflicts, the media may miss the majority of violent events.

Purpose: Review the effectiveness, cost-effectiveness, and implementation challenges of intensive blood pressure (BP) control and team-based care initiatives. Recent Findings: Intensive BP control is an effective and cost-effective intervention, yet implementation in routine clinical practice is challenging. Several models of team-based care for hypertension management have been shown to be more effective than usual care to control BP. Additional research is needed to determine the cost-effectiveness of team-based care models relative to one another and as they relate to implementing intensive BP goals. Summary: As a focus of healthcare shifts to value (i.e., cost, effectiveness, and patient preferences), formal cost-effectiveness analyses will inform which team-based initiatives hold the highest value in different healthcare settings with different populations and needs. Several challenges, including clinical inertia, financial investment, and billing restrictions for pharmacist-delivered services, will need to be addressed in order to improve public health through intensive BP control and team-based care.

Background: Multiple states have not expanded Medicaid under the Affordable Care Act, resulting in higher uninsured rates in states with high stroke burdens. This study aimed to evaluate the association of Medicaid expansion with changes in health insurance coverage, severity of presentation, access to care, and outcomes among patients with acute ischemic stroke. Methods: A retrospective, difference-in-differences analysis of Get With The Guidelines–Stroke registry data. The study population comprised first-time ischemic stroke admissions from 2012 to 2018 for patients aged 19 to 64 in 45 states (27 that expanded Medicaid and 18 that did not). A probable low-income cohort was defined based on having Medicaid, no insurance/self-pay, or undocumented insurance. Outcomes analyzed were indicators of health insurance status, stroke severity, use of emergency services, time to acute care, in-hospital mortality, receipt of rehabilitation, discharge disposition, and level of disability. Results: In the starting population (N=342 765), Medicaid-covered stroke admissions rose from 12.2% to 18.1% in expansion states and from 10.0% to only 10.6% in nonexpansion states, while uninsured admissions declined from 15.0% to 6.7% in expansion states and from 24.0% to 19.2% in nonexpansion states. In the low-income cohort (N=95 086; 28% of starting population), Medicaid expansion was associated with increased odds of discharge to a skilled nursing facility (adjusted odds ratio, 1.33 [95% CI, 1.12–1.59]) and transfer to any rehabilitation facility among those eligible (adjusted odds ratio, 1.24 [95% CI, 1.08–1.41]) and lower odds of discharge home (adjusted odds ratio, 0.89 [95% CI, 0.80–0.98]). Expansion was not associated with any other outcomes. Conclusions: Medicaid expansion is associated with fewer uninsured hospitalizations for acute ischemic stroke and increased rehabilitation at skilled nursing facilities. More targeted interventions may be needed to improve other stroke outcomes in the low-income US population. Future research should evaluate the impact of health care reform on primary stroke prevention.

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BACKGROUND: Evidence suggests that cost sharing adversely affects appropriate prescription drug use for chronic disorders. However, few studies have evaluated this effect in heart failure (HF), the most common cause of hospitalization in Medicare.OBJECTIVE: To determine whether spending on HF pharmacotherapy by Medicare Part D enrollees was associated with prescription refill adherence.METHODS: This correlational study used pooled data from the 2010-2012 Medicare Current Beneficiary Survey (MCBS). The analysis sample consisted of community-dwelling MCBS participants with self-reported HF and continuous Part D coverage during the year of participation. 3 drug classes were analyzed independently: beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs). 1,448 weighted participant-year records (derived from 964 individuals) met the inclusion criteria, of which 846 (58%) were included for beta-blockers, 633 (44%) for ACE inhibitors, and 229 (16%) for ARBs. Spending was measured by average out-of-pocket payment for the relevant prescription, standardized to a 30-day supply, as a percentage of average monthly income. Adherence was measured by the medication possession ratio (MPR): total days supplied for all but the last refill divided by number of days between the first and last fills of the year. RESULTS: Accounting for sampling weights, the median (interquartile range) monthly income was $1,472 ($949-$2,466), and average percentage of monthly income spent on a 30-day medication supply was 0.22% for beta-blockers, 0.19% for ACE inhibitors, and 0.90% for ARBs. Mean MPR was 88.9% for beta-blockers, 88.5% for ACE inhibitors, and 90.4% for ARBs. Risk-adjusted models showed that percentage of income spent on a beta-blocker prescription was directly associated with odds of nonadherence (MPR < 80%), odds ratio = 1.38, 95% CI = 1.01-1.89, P = 0.045, and inversely associated with beta-blocker MPR, B = -4.17, SE = 1.23, P = 0.001. No such association was observed for ACE inhibitors or ARBs. CONCLUSIONS: Price sensitivity was evident for beta-blockers but not for antiangiotensin drugs, despite very low out-of-pocket costs and high adherence. This study is relevant to value-based pricing of HF management drugs in Part D plans.